Vitaly Vladimirovich KovalchukCity Hospital, Russian Federation
Title: Correction of a Neglect-syndrome and Push-syndrome in movements and cognitive rehabilitation in patients with severe brain lesion
The main factors impeding carrying out of adequate rehabilitation of patients with stroke, brain injuries and other severe brain lesion are Neglect-syndrome (loss ability to react to influences or to perceive the information from the side opposite to the defeated hemisphere), and Push-syndrome (disorders of the dominated pose in sitting position – deviation at the defeated side, and the difficulties with patient’s verticalization – impossibility to transfer bodie’s weight at a healthy foot).
Therefore, it’s very important to verify these syndromes.
Push-syndrome often forms in the presence of a Neglect-syndrome.
It is necessary to find out the dominating patient's pose in a sitting position before the beginning of rehabilitation because the type of this pose will influence the choice of rehabilitation methods.
There are two such pathological poses.
Pull-syndrome – a patient "moves" himself on a healthy part of a body (the primary area of a support – a buttock area of a healthy part).
The recommendation to elimination of pull-syndrome is to avoid a fixed support (a wall, a cupboard & so on) from a healthy part of a body whilst rising and walking at early stages of rehabilitation. But unfortunately, we can see this sad situation not seldom.
Push-syndrome – deviation at the defeated side, and the difficulties with patient’s verticalisation – impossibility to transfer body’s weight to a healthy foot. We have a paradoxical situation: a patient’s paretic leg is ready to walk but healthy leg can’t support it.
A Neglect is Residual ability to react on influences or to perceive the information from the side opposite to the damaged hemisphere. The brain blocks information about the left part of a body and of a space.
There are three kinds of ignoring.
1. Representative ignoring
2. Movement ignoring
3. Sensory ignoring
There are six signs of a Neglect-syndrome:
• a gemi-inattention (absence of the adequate patient’s answer to the irritating stimulus, such as approach of people, various sounds);
• tactile fading (ability loss to react to tactile stimulus at simultaneous tactile stimulation of both sides);
• visual fading (ability loss to react to visual stimulus at simultaneous stimulation of both fields of vision);
• alloesthesia (sensation of stimulus on the opposite to stimulation side);
• anozognosia (negation of disorders of neurological functions);
• negation of an accessory of extremities of one side to the own body.
If a patient has one of these signs at least we must verify a Neglect-syndrome and we must strictly observe the rules of maintaining the patient with a Neglect.
A Neglect-syndrome takes the second place among factors which are impeding an adequate recovery of patients
City Hospital No 38 named after N.A. Semashko, Saint Petersburg