Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study

Objective: We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients. Design: Assessor-blinded, pilot randomized controlled study. Participants: A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group (N=7, computer-generated interactive visual feedback training) or control group (N=5, mirror visual feedback training). Main outcome measures: The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining. Results: A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 1.1 and 1.4 +/- 1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 +/- 4.3 and 7.2 +/- 1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 +/- 2.2 and 5.6 +/- 3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome (p<0.01) and balance (p<0.05) compared with the mirror visual feedback training program. Conclusions: Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training.