Managing the “Pusher” – NDT Workshop in the Management of Adults with Stroke and Brain Injury – September 5, 2024

Workshop Description:

This one-day workshop provides an opportunity for health care professionals to gain insight into managing the individual with contraversive pushing tendencies (“pusher syndrome”).  The individual who suffers from a stroke and has “pushing” tendencies presents with unique impairments that challenges health care professionals.  Patients that “push” have potential to make gains like our other non-pushing patients.  We struggle in treatment because “pushers” not only have impairments like our non-pushing stroke patients, but they also don’t use their “strong” side in a typical way. It is critical that we treat “pushers” as a team, often requiring a second therapist/therapy assistant to progress them in therapy. We will explore how to facilitate the affected/weak side as well as how the second person can inhibit the pushing tendencies.

This workshop will present current theoretical evidence and practical NDT skills for participants to use when working with the individual who “pushes”.  The overall objective of this course is to enable participants to bring information back to their facility and apply it toward promoting more functional movement and achieving functional outcomes with their patients.

Course Learning Objectives:

Upon completion of the course the participants will:

• • Understand current literature and apply this within the NDTA™ Contemporary Practice Model to treat the individual with neurological impairments
  • Explore treatment strategies (including using a second person to inhibit the “pushing”) to address impairments within functional activities including activities in sitting, standing and early gait.
  • Demonstrate basic handling skills to enhance patient’s functional movement as related to his/her functional goals including activities in sitting, standing and gait.
  • Demonstrate an increased repertoire of evaluation and treatment strategies for the individual with stroke who have “pushing” tendencies.

Instructor: Karen Guha, PT, CIDN, C/NDT, NDTA™ Coordinator Instructor

Karen is a physiotherapist at Grand River Hospital and Back Works Spinal and Sports Rehabilitation.  She received her Physical Therapy degree from the University of Toronto in 1996 and became NDT trained in 1999. Karen became a NDTA™ PT Instructor in 2007 and a NDTA™ Coordinator Instructor in 2011.  In 2017 Karen completed her certification in Integrated Dry Needling.  Karen has over 25 years’ experience working with adults with neurological impairments in acute, rehabilitation and outpatient settings.  Karen has taught NDT courses throughout North America and internationally.

Course Format:

This workshop will include a short lecture and then laboratory practical sessions for the remainder of the day. During lab sessions, participants will have the opportunity to analyze normal movement and practice handling skills to facilitate functional movement patterns in normal adults. Participants will have the opportunity to problem solve how these handling skills will be modified when treating the individual who has contraversive pushing tendencies.

Requirements:

Participants must be a Physical Therapist, Occupational Therapist, Speech Language Pathologist, Therapy/Rehab Assistant or Kinesiologist.

Workshop Agenda: 

• 9:00 – 9:15       Introduction
• 9:15 – 10:30     Lecture: The “Pusher”
• 10:30 -10:45   Break
• 10:45 -12:30   Lab: Strategies in Sitting (lateral weight shift, “time out”, progression in sitting, inhibit the push, foot jail, 2-person stand)
• 12:30-1:15       Lunch
• 1:15 -3:00       Labs: Strategies in Standing (managing the push in standing, facilitating the more involved side – stepping, early gait), Gait, Intervention ideas using the stairs
• 3:00 -3:30     Discussion: Splints, slings and supports
• 3:00-3:30      Wrap up

Please note that this workshop has reached capacity. You may indicate your interest to be added to the waitlist by emailing Tina Vallentin, Regional Stroke Education and Data Coordinator, at vallent@hhsc.ca.

**Please note that this workshop will take place at St. Peter’s Hospital, in Hamilton, Ontario and is only open to stroke care providers in the Central South Region. 

In your response, include the following information:

• Work Email
• Profession
• Place of work  
• Role in the stroke continuum (i.e., acute, inpatient rehab, community, etc.)