Dr. Jessica Nolan, a physiotherapist and researcher from Perth, Australia, shares her insights on lateral pulsion, a condition often overlooked in stroke rehabilitation. She discusses her PhD findings and the complexities of classifying and assessing this phenomenon. The talk emphasizes the importance of extended rehab, innovative assessment methods, and the psychological aspects surrounding patient care. Treatment strategies underscore the vital role of vestibular assessment and caregiver training, all while advocating for greater awareness and evidence-based practices in the field.
Dr. Jess Nolan's research highlights the need for clearer definitions of lateral pulsion to improve clinical understanding and treatment approaches.
Lateral pulsion prevalence varies greatly among stroke patients, complicating accurate diagnosis and necessitating tailored rehabilitation strategies.
Effective management of lateral pulsion requires active patient engagement through evidence-based rehabilitation methods, including tactile and proprioceptive cues.
Deep dives
Dr. Jess Nolan's Journey and Expertise
Dr. Jess Nolan, a physiotherapist from Perth, Australia, shares her extensive background in stroke rehabilitation, having worked as a senior physiotherapist and now a researcher and educator at Curtin University. Her interest in lateral pulsion, a complex post-stroke condition, stems from firsthand experiences in rehab settings where patients demonstrated challenging behaviors that were difficult to manage and assess. Through her PhD, Jess focused on how to better understand and treat these patients, recognizing a gap in clinical research and practice regarding lateral pulsion and its implications for rehabilitation outcomes. Her role in various committees highlights her commitment to advancing knowledge and practices related to neurorehabilitation, specifically within the Australian New Zealand Stroke Organization.
Understanding Lateral Pulsion
Lateral pulsion, previously referred to as pusher syndrome, is characterized by patients actively resisting weight shifts toward their less affected side, resulting in a visible lean towards their hemiplegic side. Through her research, Jess emphasized the need for clearer definitions and understanding of lateral pulsion, as many clinicians may have been trained under outdated concepts that do not accurately reflect the spectrum of the condition. Her findings indicate that patients can experience mild forms of lateral pulsion, which can still impact their rehabilitation outcomes and increase the likelihood of falls. Notably, Jess highlighted the importance of recognizing that lateral pulsion is not solely a behavior but rather a neurophysiological condition requiring targeted therapeutic approaches.
Challenges in Treating Lateral Pulsion
One of the significant challenges in managing lateral pulsion includes the variability in its prevalence and presentation among stroke patients, which can complicate treatment strategies. Jess mentioned that the existing literature on lateral pulsion's prevalence varies greatly, ranging from less than 10% to over 60% among stoke patients, leading to potential underdiagnosis and inadequate rehabilitation resources. Additionally, the complexity of coexisting impairments, such as neglect and cognitive deficits, further complicates treatment, as these factors can influence a patient's ability to engage in rehabilitation effectively. Understanding these challenges is crucial for clinicians to provide appropriate interventions tailored to the specific needs of each patient.
Rehabilitation Strategies for Lateral Pulsion
In her discussion, Jess outlined various evidence-based rehabilitation strategies to manage lateral pulsion effectively, emphasizing the significance of active patient engagement rather than relying on passive corrections. She recommended using tactile and proprioceptive cues to facilitate midline orientation, moving away from traditional visual cues that may not be as effective. Jess also highlighted the need for increased rehabilitation time for patients with lateral pulsion, suggesting that extending their inpatient stay could lead to better functional outcomes and increased chances of returning home. Ultimately, she stressed the importance of interdisciplinary education for families and caregivers to ensure consistency in approaching treatment, creating a supportive environment for the patient.
Future Directions in Lateral Pulsion Research
Looking ahead, Jess expressed her desire to explore the gaps in current research regarding lateral pulsion and its impact on treatment outcomes, calling for standardized assessments and a better understanding of the underlying mechanisms. One of her goals is to investigate the validity of current funding models for rehabilitation and whether they accurately reflect the needs of patients with lateral pulsion. The development and testing of specific treatment guidelines through research initiatives could help enhance clinical practice and improve patient care. Jess concluded that ongoing dialogue within the neuro rehabilitation community is necessary to address these complexities and to continue advocating for patients facing the challenges of lateral pulsion.
Dr Jess Nolan recently completed her PhD on Lateropulsion. Jess is a physio from Perth, Australia. Her credentials include BSc (Physio) - Curtin Uni, Grad Dip (Neuro Rehab) – UWA, member of ANZSO Emerging Stroke Clinician Scientist Committee, and Physio Working Party for the Stroke Foundation Living Guidelines. Jess worked as a senior physio, a physio coordinator of stroke services and is now at Curtin University in a teaching & research role. This episode is all about Jess’ PhD journey and results. Lots of lateropulsion clinical application in this one.
2.00 sec Intro
2.28 Career pathway/Interest in Lateropulsion
8.45 What is lateropulsion? Can it be mild?
13.20 Prevalence
14.05 Outcome Measures
18.29 Verticality
22.38 Assessing SVV – bucket method
23.00 PhD results - LOS needs, ANSNAP LOS predication accuracy, 1 year outcomes
37.10 Unknown pathophysiology of lateropulsion
40.20 Other components of lateropulsion – SPV – graviception, vestib impairment
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